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Senior Medical Director, Utilization Management Operations - Charles City, United States - Oscar Health
Description
2 days agoBe among the first 25 applicants
Hi, we're Oscar. We're hiring a Senior Medical Director to join our Utilization Management Operations team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members.
We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About The RoleYou will oversee the operations of Utilization Management.
You will lead a team of clinical leaders who provide oversight of clinicians, provide leadership to managers and are accountable for overall team performance metrics.
In collaboration with partners, you will play a key role in strengthening function and driving clinical improvement within the organization.
You will report to the VP, Clinical Operations.Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C.
Pay Transparency:
The base pay for this role is: $280,800 - $368,550 per year.
You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.
ResponsibilitiesOversee team of clinicians, including nurses and physicians
Ensure team is meeting quality and productivity metrics
Partner with internal teams to drive continuous improvement
Develop a working mastery with applicable regulatory and accreditation requirements and ensure the department / team is meeting those requirements
Participate in quality improvement activities (e.g., subcommittees, audits, QA, interrater reliability testing)
Partner with leads across the organization as necessary in order to communicate , understand and identify upstream and downstream impacts to the business
Support departmental budgeting process including support business case justification for major investments
Serve as point of accountability for escalated clinical issues, including internal and external appeals, member and provider complaints and grievances, and complex case management escalations
Conduct timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence based research
Compliance with all applicable laws and regulations
Other duties as assigned
Qualifications
Licensure:
MD or DO with a current unrestricted license to practice medicine is required
Reviewers must maintain necessary credentials to retain the position including maintaining active board certification
Willing and able to obtain additional state licensure (with Oscar's support)
Experience:
12+ years of experience in the healthcare industry, including:5+ years of clinical practice and board certification in one of the following specialties: internal medicine, family medicine, general surgery, emergency medicine (other specialties will be considered)
5+ years of utilization management experience in managed care
7+ years experience leading people and teams
Experience with Affordable Care Act insurance products
Bonus Points
Licensure:
Licensure in multiple Oscar states
Masters degree or advanced certificate
Experience:
Experience with conducting quality-of-care investigations and peer reviews and developing performance improvement plans
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices.
It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support.
We're on a mission to change health care an experience made whole by our unique backgrounds and perspectives.Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.
Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation:
Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ) to make the need for an accommodation known.
Seniority level
Seniority level
Director
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Full-time
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